April 15, 2009

Patients gain as doctors befin 'Group Practise'

When Mahendran (name changed) was referred to the Apollo Hospitals, Chennai for a surgical intervention, he was surprised to note that his medical record mentioned him being admitted based on a recommendation by the Surge group', and not by an independent doctor.

The Surge (surgical gastroenterologist) group, formed a month ago at the hospital, comprises three surgical gastroenterologists, including one laparoscopic surgeon. As is done in the US, the group handles patient care as a team, and amounts billed and received are shared. The big advantage for Mahendran: he not only received three expert opinions about the surgery but also round-the-clock service from specialists, all for the fee he would have been charged if he was referred to an independent consultant.

"It's not easy for doctors working independently to give round-the-clock attention to patients," says Dr T K Neelamekam, consultant-surgical gastroenterologist, Apollo Hospitals. He is a partner in the Surge group. "There are times when you have to operate late into the night. After such long surgeries, doctors either push themselves to come and check the patient's condition the following noon or leave it to their assistants till they return the following evening. It is not fair on the patient. It's also unfair to ask doctors not to go on holidays or take a few days leave. When a group of doctors practise, one doctor is always there to take important decisions."

In Chennai, group practice has become increasingly popular among doctors over the past two years. Apollo, for instance, has a group of anesthetists the Delphi Anesthetics and Pain-management (DAPS) group that works as a team.

In many maternity hospitals, group practice has become an unsaid rule. There are times when a patient lands up in labour and her consultant is not around. To avoid this, hospitals now try and ensure that all doctors in the group see the patient by turn when she visits for monthly check-ups.

A few oncologists that started group practise in the city about two years ago have been successful. Says leading orthopaedic surgeon Dr George Thomas, "Unfortunately, it is not easy to evolve as you need like-minded people. I was impressed with the way it works and even tried to evolve a super speciality group but it did not take off."

Patients are happy with all the attention they are getting. "Never once was I told that I would have to wait for the doctor's decision. My relatives received round-the-clock inputs about my condition every day," Mahendran says. What's more, he made just one consolidated payment, which the surgeons divided based on an agreed formula.

Usually, doctors in a group share the amounts equally. A substantial portion of amounts are reserved for academics and clinical research. "This results in us taking to clinical research and medical education programmes," says P Radhakrishna, a member of the Surge group.

Dr Balachandran Premkumar, laproscopic surgeon, can now afford to take a day off. "When you get a couple of difficult cases at the same time it can drive you up the wall," he says, but now I am happy and the patient is happy, too."

Link: Original Article

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